Intracoronary stents

Reducing restenosis after angioplasty

Coronary angioplasty has become an accepted treatment for coronary disease, with over 13 000 procedures performed in Britain in 1995 (410 000 in the United States). During the 1980s the overall primary success rate of angioplasty was 90%, with complications such as myocardial infarction, emergency surgery, and death occurring in up to 0.9%, 3.2%, and 1.2% of cases respectively, depending on the extent of coronary disease.1 However, even with recent improvements in angioplasty technology, percutaneous revascularisation techniques have been limited by restenosis, predominantly through neointimal hyperplasia, but also through vessel shrinkage (adverse remodelling).2 Angiographic restenosis occurs in 30–50% of cases by six months' follow up, with clinical (symptomatic) restenosis in most of these cases.1 With no pharmacological treatment consistently reducing the restenosis rate in randomised studies, there has been an increased need for reintervention with further angioplasty or bypass surgery in 44% over the first three years of follow up, offsetting the initial savings in cost …